van Lanen Rick H G J, Hoeberigs M C, Bauer N J C, Haeren R H L, Hoogland G, Colon A, Piersma C, Dings J T A, Schijns O E M G
Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Neurosurgery, Maastricht University Medical Centre, PO box 5800, 6202 AZ, Maastricht, The Netherlands.
Acta Neurochir (Wien). 2018 Jul;160(7):1325-1336. doi: 10.1007/s00701-018-3525-9. Epub 2018 Apr 5.
Anterior temporal lobectomy (ATL) as a treatment for drug-resistant temporal lobe epilepsy (TLE) frequently causes visual field deficits (VFDs). Reported VFD encompasses homonymous contralateral upper quadrantanopia. Its reported incidence ranges from 15 to 90%. To date, a quantitative method to evaluate postoperative VFD in static perimetry is not available. A method to quantify postoperative VFD, which allows for comparison between groups of patients, was developed.
Fifty-five patients with drug-resistant TLE, who underwent ATL with pre- and postoperative perimetry, were included. Temporal lobe resection length was measured on postoperative MRI. Percentage VFD was calculated for the total visual field, contralateral upper quadrant, or other three quadrants combined.
Patients were divided into groups by resection size (< 45 and ≥ 45 mm) and side of surgery (right and left). We found significant higher VFD in the ≥ 45 vs. < 45 mm group (2.3 ± 4.4 vs. 0.7 ± 2.4%,p = 0.04) for right-sided ATL. Comparing VFD in both eyes, we found more VFD in the right vs. left eye following left-sided ATL (14.5 ± 9.8 vs. 12.9 ± 8.3%, p = 0.03). We also demonstrated significantly more VFD in the < 45 mm group for left- vs. right-sided surgery (6.7 ± 6.7 vs. 13.1 ± 7.0%, p = 0.016). A significant quantitative correlation between VFD and resection size for right-sided ATL was shown (r = 0.52, p < 0.01).
We developed a new quantitative scoring method for the assessment of postoperative visual field deficits after temporal lobe epilepsy surgery and assessed its feasibility for clinical use. A significant correlation between VFD and resection size for right-sided ATL was confirmed.
前颞叶切除术（ATL）作为耐药性颞叶癫痫（TLE）的一种治疗方法，经常会导致视野缺损（VFDs）。报道的视野缺损包括对侧同向性上象限盲。其报道的发生率在15%至90%之间。迄今为止，尚无一种在静态视野检查中评估术后视野缺损的定量方法。我们开发了一种量化术后视野缺损的方法，该方法可用于患者组间的比较。
纳入55例接受了ATL且术前行视野检查和术后行视野检查的耐药性TLE患者。在术后MRI上测量颞叶切除长度。计算总视野、对侧上象限或其他三个象限组合的视野缺损百分比。
根据切除大小（<45和≥45mm）和手术侧别（右侧和左侧）将患者分组。我们发现，对于右侧ATL，≥45mm组的视野缺损明显高于<45mm组（2.3±4.4对0.7±2.4%，p=0.04）。比较双眼的视野缺损，我们发现左侧ATL后右眼的视野缺损多于左眼（14.5±9.8对12.9±8.3%，p=0.03）。我们还证明，对于左侧与右侧手术，<45mm组的视野缺损明显更多（6.7±6.7对13.1±7.0%，p=0.016）。显示右侧ATL的视野缺损与切除大小之间存在显著的定量相关性（r=0.52，p<0.01）。
我们开发了一种新的定量评分方法，用于评估颞叶癫痫手术后的术后视野缺损，并评估了其临床应用的可行性。证实了右侧ATL的视野缺损与切除大小之间存在显著相关性。
